U.S. patent application number 13/543960 was filed with the patent office on 2012-10-25 for articulating medical instrument.
This patent application is currently assigned to Novolap Medical Ltd.. Invention is credited to Eliahu Eliachar, Ram Grossfeled, Gilad Heftman, Gilad Lavi, Nir Lilach, Mordehai Sholev.
Application Number | 20120271285 13/543960 |
Document ID | / |
Family ID | 44022228 |
Filed Date | 2012-10-25 |
United States Patent
Application |
20120271285 |
Kind Code |
A1 |
Sholev; Mordehai ; et
al. |
October 25, 2012 |
ARTICULATING MEDICAL INSTRUMENT
Abstract
An articulating medical instrument comprising of: a
substantially straight proximal segment; a substantially straight
distal segment; an articulation mechanism having a straight
configuration in which the proximal and distal segments form a
substantially straight line and at least one articulated
configuration in which the proximal and distal segments form an
articulation angle of less than 180 degrees between the segments,
the articulation mechanism being configured for increasing or
decreasing the articulation angle; and one or more drive mechanisms
configured for transferring force from the proximal segment to the
distal segment, wherein the drive mechanism does not follow
substantially straight lines between the proximal and distal
segments passing through the apex of the articulation angle.
Inventors: |
Sholev; Mordehai; (Moshav
Amikam, IL) ; Lilach; Nir; (Moshav Kfar Yehoshua,
IL) ; Grossfeled; Ram; (Haifa, IL) ; Eliachar;
Eliahu; (Haifa, IL) ; Lavi; Gilad;
(Rishon-LeZion, IL) ; Heftman; Gilad; (Kibbutz
Ein-Gev, IL) |
Assignee: |
Novolap Medical Ltd.
Maccabim-Reut
IL
|
Family ID: |
44022228 |
Appl. No.: |
13/543960 |
Filed: |
July 9, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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PCT/IL2011/000089 |
Jan 26, 2011 |
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13543960 |
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61298238 |
Jan 26, 2010 |
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61389303 |
Oct 4, 2010 |
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Current U.S.
Class: |
606/1 |
Current CPC
Class: |
A61B 2017/00398
20130101; A61B 17/068 20130101; A61B 10/0045 20130101; A61B
2017/00898 20130101; A61B 2217/005 20130101; A61B 17/29 20130101;
A61B 2017/2903 20130101; A61M 5/31581 20130101; A61B 2017/0648
20130101; A61B 2017/2927 20130101; A61B 2017/2902 20130101 |
Class at
Publication: |
606/1 |
International
Class: |
A61B 17/00 20060101
A61B017/00 |
Claims
1. An articulating medical instrument comprising of: a
substantially straight proximal segment; a substantially straight
distal segment connected to the proximal segment; an articulation
mechanism for changing an articulation angle between the proximal
and distal segments and providing a straight configuration in which
the proximal and distal segments form a substantially straight line
and at least one articulated configuration in which the proximal
and distal segments form an articulation angle of less than 180
degrees between the segments, the articulation mechanism being
configured for increasing or decreasing the articulation angle; and
one or more drive mechanisms configured for transferring rotation
from the proximal segment to the distal segment, at least one drive
mechanism being contained within the segments in the straight
configuration, wherein at least a portion of the at least one drive
mechanism is external to at least a portion of at least one segment
adjacent to the connection between the segments in the articulated
configuration.
2. An instrument according to claim 1, wherein at least one drive
mechanism does not pass through the apex of the articulation
angle.
3. An instrument according to claim 1, wherein at least one drive
mechanism is positioned interior of the articulation angle.
4. An instrument according to claim 1, wherein the articulation
mechanism comprises a lever and wherein the at least one drive
mechanism is positioned between the articulation angle and the
lever.
5. An instrument according to claim 4, wherein the lever is
positioned interior of the articulation angle.
6. An instrument according to claim 1, wherein at least one drive
mechanism is configured to transfer linear movement from a proximal
end of the instrument to a distal end of the instrument.
7. An instrument according to claim 1, wherein a medical tool is
positioned in or at the distal segment and wherein the drive
mechanism is configured to actuate the medical tool.
8. An instrument according to claim 1, further comprising a sheath
covering the articulation mechanism and the drive mechanism.
9. An instrument according to claim 1, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a gear mechanism.
10. An instrument according to claim 1, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a flexible shaft.
11. An instrument according to claim 1, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a spring.
12. An instrument according to claim 11, wherein a wire passes
through said spring.
13. An instrument according to claim 1, wherein the proximal and
distal segments are connected by a flexible joint.
14. An instrument according to claim 1, wherein the drive mechanism
and articulation mechanism are not fixedly connected at the
connection between the proximal and distal segments.
15. An instrument according to claim 1, wherein the drive mechanism
is not substantially affected by external forces applied against
maintaining the articulation angle.
16. An instrument according to claim 1, further comprising a
distance compensation mechanism for compensating the distance at
the point of attachment of the drive mechanism to the distal and
proximal segments in the articulated configuration as the
articulation angle changes.
17. An articulating medical instrument comprising of: a
substantially straight proximal segment; a substantially straight
distal segment; an articulation mechanism having a straight
configuration in which the proximal and distal segments form a
substantially straight line and at least one articulated
configuration in which the proximal and distal segments form an
interior articulation angle of less than 180 degrees between the
segments, the articulation mechanism being configured for
increasing or decreasing the articulation angle; and one or more
drive mechanisms configured for transferring force from the
proximal segment to the distal segment, wherein at least one drive
mechanism is positioned exterior of the articulation angle.
18. An instrument according to claim 17, wherein the articulation
mechanism comprises a lever extending out of the proximal segment
and wherein the drive mechanism is positioned between the lever and
the proximal segment.
19. An instrument according to claim 17, wherein at least one drive
mechanism is configured to transfer rotary movement from a proximal
end of the instrument to a distal end of the instrument.
20. An instrument according to claim 17, wherein the drive
mechanism is positioned in the same plane as the segments.
21. An instrument according to claim 17, wherein at least one drive
mechanism is configured to transfer linear movement from a proximal
end of the instrument to a distal end of the instrument.
22. An instrument according to claim 17, wherein a medical tool is
positioned in or at the distal segment and wherein the drive
mechanism is configured to actuate the medical tool.
23. An instrument according to claim 17, further comprising a
sheath covering the articulation mechanism and the drive
mechanism.
24. An instrument according to claim 17, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a gear mechanism.
25. An instrument according to claim 17, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a flexible shaft.
26. An instrument according to claim 17, wherein the at least one
drive mechanism for transferring rotation from the proximal segment
to the distal segment comprises a spring.
27. An instrument according to claim 26, wherein a wire passes
through said spring.
28. An instrument according to claim 17, wherein the proximal and
distal segments are connected by a flexible joint.
29. An instrument according to claim 17, wherein the drive
mechanism and articulation mechanism are not fixedly connected at
the connection between the proximal and distal segments.
30. An instrument according to claim 17, wherein the drive
mechanism is not substantially affected by external forces applied
against maintaining the articulation angle.
31. An instrument according to claim 17, further comprising a
distance compensation mechanism for compensating the distance at
the point of attachment of the drive mechanism to the distal and
proximal segments in the articulated configuration as the
articulation angle changes.
32. An instrument according to claim 17, further comprising a
handle attached to the proximal segment, wherein the drive and
articulation mechanism are controllable from the handle.
33. An instrument according to claim 17, further comprising an
adaptor for attaching the instrument to an existing handle.
34. An articulating medical instrument comprising of: a
substantially straight proximal segment; a substantially straight
distal segment connected to the proximal segment, the distal
segment containing a threaded shaft around which a plurality of
helical fasteners are screwed; an articulation mechanism for
changing an articulation angle between the proximal and distal
segments and providing a straight configuration in which the
proximal and distal segments form a substantially straight line and
at least one articulated configuration in which the proximal and
distal segments form an articulation angle of less than 180 degrees
between the segments or extensions of the segments, the
articulation mechanism being configured for articulating the distal
segment towards or away from the proximal segment; and a drive
mechanism configured for transferring rotary movement from the
proximal segment to the distal segment such that the fasteners
distally exit the threaded shaft, wherein the drive mechanism is
contained within the segments in the straight configuration and at
least a portion of the drive mechanism is external to at least a
portion of at least one segment adjacent to the connection between
the segments in the articulated configuration.
35. An articulating medical instrument comprising of: a
substantially straight proximal segment; a substantially straight
distal segment connected to the proximal segment, the distal
segment containing: a plurality of threaded fasteners comprising
wings; a tube having longitudinal slots in which the helical
fasteners are positioned such that the wings exit through the
slots; and an internally threaded outer layer into which the wings
of the fasteners are screwed; an articulation mechanism for
changing an articulation angle between the proximal and distal
segments and providing a straight configuration in which the
proximal and distal segments form a substantially straight line and
at least one articulated configuration in which the proximal and
distal segments form an articulation angle of less than 180 degrees
between the segments or extensions of the segments, the
articulation mechanism being configured for articulating the distal
segment towards or away from the proximal segment; and a drive
mechanism configured for transferring rotary movement from the
proximal segment to the distal segment such that the tube rotates
causing the fasteners to exit the distal segment, wherein the drive
mechanism is contained within the segments in the straight
configuration and wherein at least a portion of the drive mechanism
is external to at least a portion of at least one segment adjacent
to the connection between the segments in the articulated
configuration.
36. An instrument according to claim 34, wherein the drive
mechanism is positioned exterior of the articulation angle.
37. An instrument according to claim 36, wherein the articulation
mechanism comprises a lever and wherein the drive mechanism is
positioned between the articulation angle and the lever.
38. An instrument according to claim 37, wherein the lever is
positioned interior of the articulation angle.
39. An instrument according to claim 34, wherein the drive
mechanism is positioned interior of the articulation angle.
40. An instrument according to claim 39, wherein the articulation
mechanism comprises a lever extending out of the proximal segment
and wherein the drive mechanism is positioned between the
articulation angle and the proximal segment.
41. An instrument according to claim 34, wherein the drive
mechanism configured for transferring rotary movement from the
proximal segment to the distal segment comprises a gear
mechanism.
42. An instrument according to claim 34, wherein the drive
mechanism configured for transferring rotary movement from the
proximal segment to the distal segment comprises a flexible
shaft.
43. An instrument according to claim 34, wherein the drive
mechanism configured for transferring rotary movement from the
proximal segment to the distal segment comprises a spring.
44. An instrument according to claim 43, wherein a wire passes
through said spring.
45. An instrument according to claim 34, further comprising a
distance compensation mechanism for compensating the distance at
the point of attachment of the drive mechanism to the distal and
proximal segments in the articulated configuration as the
articulation angle changes.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of PCT Patent Application
No. PCT/IL2011/000089 having International filing date of Jan. 26,
2011, which claims the benefit of priority of U.S. Provisional
Patent Application Nos. 61/298,238 filed on Jan. 26, 2010 and
61/389,303 filed on Oct. 4, 2010. The contents of the above
applications are all incorporated herein by reference in their
entirety.
FIELD AND BACKGROUND OF THE INVENTION
[0002] The present invention, in some embodiments thereof, relates
to an articulating medical instrument and, more particularly, but
not exclusively, to an articulating medical instrument having a
drive mechanism.
[0003] A number of articulating medical instruments and methods are
known in the art.
[0004] U.S. Pat. No. 6,913,613 to Schwarz et al. describes a
surgical instrument having a hollow shank having a proximal end and
a distal end, an actuating device arranged at the proximal end, and
an instrument tip bendable or pivotal toward the shank which
carries a mouth part arranged at the distal end thereof. A gear
mechanism is further provided which transforms at least a first
movement of the actuating device into a rotation of the mouth part
according to a first specific transmission ratio in relation to the
first actuating movement. The gear mechanism mechanically couples
the actuating device to the instrument tip.
[0005] U.S. Pat. No. 7,087,071 to Nicholas et al describes a
surgical instrument for use in endoscopic or laparoscopic
procedures. The instrument includes a handle portion, an endoscopic
portion extending from the handle portion, an articulating section
pivotably connected to a distal end portion of the endoscopic
portion, and a retractor assembly operatively associated with the
articulating section. Structure is provided for manipulating the
articulating section relative to the longitudinal axis of the
endoscopic portion within an angular degree of rotation. A link rod
is connecting between the articulating section and the endoscopic
portion, wherein during manipulation of the articulating section,
the link rod may be positioned out of the axis between the
articulating section and the endoscopic portion.
[0006] U.S. Pat. No. 5,549,637 to Crainich describes an articulated
medical instrument which comprises a handle, an elongate body
member terminating in a tool head receiver and up to three joints,
each pivotable to about 60.degree., whereby the tool head receiver
is pivotable up to a total of 180.degree. relative to the straight
position thereof.
[0007] U.S. 2010/0001038 to Levin et al describes a pivoting tacker
for applying surgical fasteners such as rotary tacks, where the
tacks pass through a pivoting structure, including a plurality of
pivoting links, each including a link shaft.
[0008] U.S. Pat. No. 3,995,449 describes a joint for homokynetic
transmission of rotary motion between two concurrent shafts on
which head portions are mounted. The head portions are connected by
pairs of articulated driving-rods, each slidably and rotatedly
disposed in a respective bore in a respective head portion. All the
pairs of rods ensure the rotary transmission, and both head
portions are also hinge-coupled with double articulation line by
means of coupling-boxes loosely mounted on the head portions.
[0009] Additional background art includes U.S. Pat. No. 7,673,780,
U.S. 2009/0065549, U.S. 2008/0296343, U.S. Pat. No. 5,578,048, U.S.
Pat. No. 7,549,998, U.S. Pat. No. 5,209,747, U.S. Pat. No.
1,334,388 and EP 0 042 330.
SUMMARY OF THE INVENTION
[0010] An aspect of some embodiments of the invention relates to an
articulating medical instrument, having a proximal segment and a
distal segment, the distal segment being configured for holding a
medical tool at an end portion thereof and/or for containing
surgical objects. A drive mechanism is provided for actuating the
medical tool and/or objects. In some embodiments, the drive
mechanism does not follow substantially straight lines between the
proximal and distal segments passing through the apex of the
articulation angle between the distal segment and the proximal
segment of the instrument when articulated. In some embodiments,
the instrument further comprises an articulation mechanism for
articulating the distal segment towards the proximal segment.
[0011] According to an aspect of some embodiments of the present
invention there is provided an articulating medical instrument
comprising of:
[0012] a substantially straight proximal segment;
[0013] a substantially straight distal segment;
[0014] an articulation mechanism having a straight configuration in
which the proximal and distal segments form a substantially
straight line and at least one articulated configuration in which
the proximal and distal segments form an articulation angle of less
than 180 degrees between the segments, the articulation mechanism
being to configured for increasing or decreasing the articulation
angle; and one or more drive mechanisms configured for transferring
force from the proximal segment to the distal segment, wherein the
drive mechanism does not follow substantially straight lines
between the proximal and distal segments passing through the apex
of the articulation angle.
[0015] According to some embodiments of the invention, at least one
drive mechanism does not pass through the apex of the articulation
angle.
[0016] According to some embodiments of the invention, at least one
drive mechanism is positioned interior of the articulation
angle.
[0017] According to some embodiments of the invention, the
articulation mechanism comprises a lever and wherein the at least
one drive mechanism is positioned between the articulation angle
and the lever.
[0018] According to some embodiments of the invention, at least one
drive mechanism is positioned exterior of the articulation
angle.
[0019] According to some embodiments of the invention, the
articulation mechanism comprises a lever extending out of the
proximal segment and wherein the drive mechanism is positioned
between the lever and the proximal segment.
[0020] According to some embodiments of the invention, at least one
drive mechanism is configured to transfer rotary movement from a
proximal end of the instrument to a distal end of the
instrument.
[0021] According to some embodiments of the invention, at least one
drive mechanism is configured to transfer linear movement from a
proximal end of the instrument to a distal end of the
instrument.
[0022] According to some embodiments of the invention, a medical
tool is positioned in or at the distal segment and wherein the
drive mechanism is configured to actuate the medical tool.
[0023] According to some embodiments of the invention, the
instrument further comprises a sheath covering the articulation
mechanism and the drive mechanism.
[0024] According to some embodiments of the invention, the drive
mechanism comprises a gear mechanism.
[0025] According to some embodiments of the invention, the drive
mechanism comprises a flexible shaft.
[0026] According to some embodiments of the invention, the proximal
and distal segments are connected by a flexible joint.
[0027] According to some embodiments of the invention, the drive
mechanism and articulation mechanism are not fixedly connected at
the connection between the proximal and distal segments.
[0028] According to some embodiments of the invention, the drive
mechanism is not substantially affected by external forces
responsive applied against maintaining the articulation angle.
[0029] According to some embodiments of the invention, the
instrument further comprises a distance compensation mechanism for
compensating the distance at the point of attachment of the drive
mechanism to the distal and proximal segments in the articulated
configuration as the articulation angle changes.
[0030] According to some embodiments of the invention, the
instrument further comprises a handle attached to the proximal
segment, wherein the drive and articulation mechanism are
controllable from the handle.
[0031] According to some embodiments of the invention, the
instrument further comprises an adaptor for attaching the
instrument to an existing handle.
[0032] According to an aspect of some embodiments of the present
invention there is provided an articulating medical instrument
comprising of:
[0033] a substantially straight proximal segment;
[0034] a substantially straight distal segment, the distal segment
containing a threaded shaft around which a plurality of helical
fasteners are screwed;
[0035] an articulation mechanism having a straight configuration in
which the proximal and distal segments form a substantially
straight line and at least one articulated configuration in which
the proximal and distal segments form an articulation angle of less
than 180 degrees between the segments or extensions of the
segments, the articulation mechanism being configured for
articulating the distal segment towards or away from the proximal
segment; and
[0036] a drive mechanism configured for transferring rotary
movement from the proximal segment to the distal segment such that
the fasteners distally exit the threaded shaft, wherein the drive
mechanism does not follow substantially straight lines between the
proximal and distal segments passing through the apex of the
articulation angle.
[0037] According to an aspect of some embodiments of the present
invention there is provided an articulating medical instrument
comprising of:
[0038] a substantially straight proximal segment;
[0039] a substantially straight distal segment, the distal segment
containing: [0040] a plurality of threaded fasteners comprising
wings; [0041] a tube having longitudinal slots in which the helical
fasteners are positioned such that the wings exit through the
slots; and [0042] an internally threaded outer layer into which the
wings of the fasteners are screwed;
[0043] an articulation mechanism having a straight configuration in
which the proximal and distal segments form a substantially
straight line and at least one articulated configuration in which
the proximal and distal segments form an articulation angle of less
than 180 degrees between the segments or extensions of the
segments, the articulation mechanism being configured for
articulating the distal segment towards or away from the proximal
segment; and
[0044] a drive mechanism configured for transferring rotary
movement from the proximal segment to the distal segment such that
the tube rotates causing the fasteners to exit the distal segment,
wherein the drive mechanism does not follow substantially straight
lines between the proximal and distal segments passing through the
apex of the articulation angle.
[0045] According to some embodiments of the invention, the drive
mechanism is positioned exterior of the articulation angle.
[0046] According to some embodiments of the invention, the
articulation mechanism comprises a lever and wherein the drive
mechanism is positioned between the articulation angle and the
lever.
[0047] According to some embodiments of the invention, the drive
mechanism is positioned interior of the articulation angle.
[0048] According to some embodiments of the invention, the
articulation mechanism comprises a lever extending out of the
proximal segment and wherein the drive mechanism is positioned
between the articulation angle and the proximal segment.
[0049] According to an aspect of some embodiments of the present
invention there is to provided an articulating rotary coupler
comprising:
[0050] a proximal shaft and a distal shaft;
[0051] a plurality of rod pairs comprising a plurality of proximal
rods connected to the proximal shaft and a plurality of distal rods
connected to the distal shaft, where the proximal rods and distal
rods are interconnected by a planar joint, such that the rotary
coupler comprises a straight configuration in which the distal
shaft and proximal shaft form a substantially straight line and an
articulated configuration in which the distal shaft is articulate
around the planar joint towards the proximal shaft; and
[0052] an alignment mechanism for aligning the rod pairs such that
the distal shaft can articulate around the planar joint at any
rotational position of the shafts in the straight
configuration.
[0053] According to some embodiments of the invention, the
alignment mechanism comprises:
[0054] a plurality of cylindrical housings in which extensions of
the rods are slidably inserted, the housings including an axle
positioned eccentric of an axis of the housings;
[0055] a disk in which the knobs are positioned, the disk being
positioned eccentric of the proximal shaft.
[0056] According to some embodiments of the invention, the
alignment mechanism comprises springs between the rods and the
inside of the ends of the housings.
[0057] According to some embodiments of the invention, the
alignment mechanism is attached to the proximal shaft.
[0058] According to some embodiments of the invention, a plurality
of rod pairs comprises at least three rod pairs.
[0059] According to an aspect of some embodiments of the present
invention there is provided an articulating rotary coupler
comprising:
[0060] a proximal shaft and a distal shaft;
[0061] a plurality of rod pairs comprising a plurality of proximal
rods connected to the proximal shaft and a plurality of distal rods
connected to the distal shaft, where the proximal rods and distal
rods are interconnected by a flexible element, such that the rotary
coupler comprises a straight configuration in which the distal
shaft and proximal shaft form a substantially straight line and an
articulated configuration in which the distal shaft is articulate
around the flexible element towards the proximal shaft.
[0062] According to some embodiments of the invention, the rotary
coupler further comprises a linear compensation mechanism for the
plurality of rod pairs.
[0063] According to some embodiments of the invention, the linear
compensation mechanism comprises springs attached to an end of the
rod pairs.
[0064] Unless otherwise defined, all technical and/or scientific
terms used herein have the same meaning as commonly understood by
one of ordinary skill in the art to which the invention pertains.
Although methods and materials similar or equivalent to those
described herein can be used in the practice or testing of
embodiments of the invention, exemplary methods and/or materials
are described below. In case of conflict, the patent specification,
including definitions, will control. In addition, the materials,
methods, and examples are illustrative only and are not intended to
be necessarily limiting.
BRIEF DESCRIPTION OF THE DRAWINGS
[0065] Some embodiments of the invention are herein described, by
way of example only, with reference to the accompanying drawings.
With specific reference now to the drawings in detail, it is
stressed that the particulars shown are by way of example and for
purposes of illustrative discussion of embodiments of the
invention. In this regard, the description taken with the drawings
makes apparent to those skilled in the art how embodiments of the
invention may be practiced.
[0066] In the drawings:
[0067] FIGS. 1A-1H are schematic illustrations of an articulating
surgical instrument according to an exemplary embodiment of the
invention;
[0068] FIGS. 2A and 2B are partially cross-sectional illustrations
of a medical tool actuated with the instrument in the embodiment
illustrated in FIG. 1;
[0069] FIGS. 3A and 3B are schematic illustrations of an
articulation and drive mechanism useful in an articulated surgical
instrument similar to that of FIG. 1, in accordance with another
embodiment of the invention;
[0070] FIGS. 4A-4F are schematic illustrations of a drive mechanism
in accordance with yet another embodiment of the invention;
[0071] FIGS. 4G and 4H are partially cross-sectional illustrations
of the drive mechanism of FIGS. 4A-4E in the instrument of FIGS. 1A
and 1B.
[0072] FIGS. 5A-5E are schematic illustrations of an articulation
and drive mechanism useful in an articulated surgical instrument in
accordance with another embodiment of the invention;
[0073] FIGS. 6A-6C are schematic illustrations of the articulation
and drive mechanism of FIGS. 5A-5C, where the proximal and distal
segments are connected by a flexible hinge in accordance with an
exemplary embodiment of the invention;
[0074] FIGS. 7A-7C are schematic illustrations of an articulation
and drive mechanism of FIGS. 5A-5C using a rigid rod in accordance
with another embodiment of the invention;
[0075] FIG. 8 is a schematic illustration of a linear distance
compensation mechanism useful in a medical instrument in accordance
with an exemplary embodiment of the invention;
[0076] FIGS. 9A-9B are schematic illustrations of another linear
distance compensation mechanism useful in a medical instrument in
accordance with another embodiment of the invention;
[0077] FIG. 10 is a schematic illustration of a distance
compensation mechanism useful in a medical instrument in accordance
with an embodiment of the invention;
[0078] FIGS. 11A and 11B are partially sectioned view of a handle
of a surgical instrument in accordance with exemplary embodiments
of the invention;
[0079] FIGS. 12A and 12B are partially sectioned views of an
adaptor for a surgical instrument in accordance with an exemplary
embodiment of the invention; and
[0080] FIG. 12C is an upper view of the adaptor of FIGS. 12A and
12B.
DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION
[0081] The present invention, in some embodiments thereof, relates
to an articulating medical instrument and, more particularly, but
not exclusively, to an articulating medical instrument having a
drive mechanism.
[0082] Some embodiments of the invention relate to a medical
instrument having a proximal segment and a distal segment. The
instrument has a straight configuration in which the proximal
segment and distal segment form a substantially straight line in
which the proximal and distal segment form an angle of
substantially 180 degrees form between the segments, and an
articulated configuration, in which the proximal and distal to
portions form an articulation angle of less than 180.degree.
between the segments or extensions of the segments.
[0083] The instrument is configured for containing or carrying
medical tools and/or surgical objects at the distal segment.
Optionally, medical tools and/or surgical objects (hereinafter,
referred to collectively as "medical tools") are contained within
the distal segment. Alternatively or additionally, one or more
medical tool are attached to an end of the distal segment.
Alternatively or additionally, the medical tool(s) can be inserted
into the distal portion during maneuvering thereof and deployed
when needed. Alternatively or additionally, a conduit or the like
is inserted through the proximal and distal segments for injection
of medication or collecting of tissue samples.
[0084] An aspect of some embodiments of the invention relates to a
drive mechanism for actuating the medical tool. Preferably the
drive mechanism is controllable from the proximal segment of the
instrument, or from a handle or adaptor attached to the proximal
segment. In some embodiments of the invention, the drive mechanism
does not follow substantially straight lines between the proximal
and distal segments passing through the apex of the articulation
angle in the articulated configuration. In some embodiments, the
drive mechanism does not pass through the apex of the articulation
angle formed by the proximal segment and the distal segment in the
articulated configuration.
[0085] As used herein, the term "drive mechanism" comprises a
mechanism that transfers torque or force from the proximal segment
to the distal segment, thereby actuating a medical tool or tools at
or in the distal segment. For example, rotating a medical tool or
surgical instrument, controlling medical forceps or scissors,
actuating a tacker, injecting medication, collecting tissue
samples, etc. In some embodiments, the drive mechanism transfers
rotary motion. Alternatively or additionally, the drive mechanism
transfers linear movement, for example, pulling or pushing a
medical instrument or actuating an instrument by pulling or
pushing. Exemplary drive mechanisms are springs, rods, cardan
joints, gears, cables or flexible shafts. In some embodiments, the
drive mechanism consists of two actuation mechanisms which may be
positioned one inside the other, for example a flexible shaft
configured for transfer of rotary movement with a wire passing
through the shaft, the wire configured for transfer of linear
movement. Optionally, more than one wire or actuation device is
positioned in an additional actuation mechanism
[0086] As used herein, the articulation angle is an angle of less
than 180 degrees formed by the substantially straight distal
segment and substantially straight proximal segment in the
articulated configuration. In some embodiments, the proximal
segment comprises parts deviating from the substantially straight
segment (such as a lever), these extending parts are not considered
when defining the articulation angle. Optionally, a hinge forming
the angle is provided in the instrument. Alternatively, such a
hinge is not physically present in the instrument and the axes of
the straight segments are continued to define the articulation
angle.
[0087] As used herein, the "articulated configuration" refers to
any configuration in which proximal segment and distal segment do
not form a substantially straight line.
[0088] Optionally, the articulated configuration refers to a
configuration in which the articulation angle is more than
0.degree. and less than 180.degree., i.e. any angle between
1.degree.-179.degree., for example, 120.degree., 60.degree.,
45.degree., 8.degree. or intermediate values. The articulation
configuration refers to articulation of the proximal and distal
segments on a single plane. It is understood that the instrument,
including both segments, can rotate around its axis at any
articulated configuration.
[0089] There is further provided an articulation mechanism,
configured for articulating the distal segment towards or away from
the proximal segment. In some embodiments, the articulation
mechanism is a lever mechanism. In some embodiments, the lever
mechanism includes a sliding lever located in or attached to the
proximal segment. The lever may be pushed in order to articulate
the distal segment towards the proximal segment and be pulled in
order to articulate the distal segment away from the proximal
segment.
[0090] In some embodiments, the lever mechanism includes a sliding
lever attached at one end to the distal segment and on its other
end to the proximal segment. The lever may be pulled in order to
articulate the distal segment towards the proximal segment and be
pushed in order to articulate the distal segment away from the
proximal segment.
[0091] Optionally, the lever is positioned interior of the
articulation angle. Alternatively, the lever is positioned exterior
of the articulation angle.
[0092] In some embodiments, a hinge or joint connecting the ends of
the proximal and distal segments is provided around which the
distal segment articulates. Alternatively, the ends of the distal
and proximal segments are connected by a flexible hinge, such as a
flexible shaft, spring, etc.
[0093] Optionally, the drive mechanism starts at the proximal
segment (generally at or near its distal end) and ends in the
distal segment (generally at or near its proximal end). In passing
between these segments it may be positioned between the lever and
the articulation angle in the articulated configuration. In some
embodiments of the invention, in the articulated configuration the
drive mechanism is bent throughout at a less sharp angle than the
articulation angle. In some embodiments, the drive mechanism is
situated interior of the articulation angle, for example when the
lever is situated interior of the articulation angle. In other
embodiments, the drive mechanism is situated exterior of the
articulation angle, for example, when the lever is situated
exterior of the articulation angle. In some embodiments, the drive
mechanism is positioned on a different plane than the articulation
angle.
[0094] The drive mechanism and/or articulation mechanism may be
positioned in or parallel to the substantially straight instrument
when in its straight configuration and extend from the segments in
an articulated configuration.
[0095] In some embodiments of the invention, at the articulation
angle, parts of the drive mechanism are not fixedly connected to
parts of the articulation mechanism, whereby forces involved in
changing the articulation angle or in maintaining the articulation
angle have no or minimal effect on the drive mechanism.
[0096] In some embodiments of the invention, a distance
compensation mechanism is provided for compensating the distance at
the point of attachment of the drive mechanism to the distal and
proximal segments in the articulated configuration as the
articulation angle changes.
[0097] In some embodiments of the invention, the instrument further
comprises a sheath covering the drive mechanism and lever in order
to prevent body tissues from being caught in the mechanisms. In
some embodiments the sheath optionally also covers the hinge.
[0098] An aspect of some embodiments of the invention relates to an
articulating coupler for coupling a first and second shafts (or
segments), where the shafts freely rotate and can articulate
towards each other at any rotational position. The rotary coupler
comprises a plurality of rod pairs including a plurality of first
rods connected to the first shaft and a plurality of second rods
connected to the second shaft. The first and second rods in a pair
are preferably interconnected by a planar hinge or joint for
articulating the shafts. An alignment mechanism is provided for
aligning the planar hinge of the plurality of rod pairs such that
the rod pairs can articulate in a same direction, for any
rotational position of the rotary coupler.
[0099] In some embodiments, the alignment mechanism consists of a
plurality of circular housings having longitudinal slots in which
extensions of the first (or second) rods fit, thereby preventing
undesired rotation of the rod pairs around their axes. The housings
each include an axle which is eccentric to the circular housing,
which is connected to a circular disk, positioned eccentric to the
first shaft. The eccentric position of the axles is substantially
equal to and are in the same direction as the eccentric position of
the disk. Due to the eccentric position of the knobs and disk, as
the disk rotates, the direction of the slots remains the same and
is the same for all the slots.
[0100] An aspect of some embodiments of the invention, relates to
an articulating rotary coupler, where the rod pairs are
interconnected by a flexible element.
[0101] These rotary couplers described above may be used as a
combination drive and articulation mechanism in the embodiments
described above.
[0102] Before explaining at least one embodiment of the invention
in detail, it is to be understood that the invention is not
necessarily limited in its application to the details of
construction and the arrangement of the components and/or methods
set forth in the following description and/or illustrated in the
drawings and/or the Examples. The invention is capable of other
embodiments or of being practiced or carried out in various
ways.
[0103] Referring now to the drawings, FIGS. 1A-1B illustrate an
articulating surgical instrument 100 according to some exemplary
embodiments of the invention. Instrument 100 is a surgical
instrument, however, any medical instrument may be used in
according with embodiments of the present invention. Instrument 100
includes a handle 110, an optional adaptor 120, a substantially
straight proximal segment 130 and a substantially straight distal
segment 140.
[0104] FIG. 1A illustrates instrument 100 in a straight
configuration where proximal segment 130 and distal segment 140
form a substantially straight line. FIG. 1B illustrates an
articulated configuration in which distal segment 130 is bent
towards proximal segment 140 around a hinge 116, which is for
example a pivot or a planar hinge. In the articulated configuration
an articulation angle 135 of less than 180.degree. is formed
between distal segment 140 and proximal segment 130. According to
embodiments of the present invention, articulation angle may be any
angle between 1.degree.-179.degree., for example an angle between
45.degree.-179.degree. such as 8.degree., 60.degree., 90.degree.,
120.degree. or any intermediate number.
[0105] Optionally, a medical tool is attached to an end 142 of
distal segment 140, for example forceps or scissors. Alternatively
or additionally, a medical tool or surgical instruments are
contained within segment 140, for example a needle and/or screws,
tacks or anchors. Optionally, a conduit is inserted through segment
130 and segment 140 for example for injecting medication or
collecting of tissue samples. Optionally, mechanisms for actuating,
dispensing and/or deploying a surgical instrument are also
contained within segment 140.
[0106] Instrument 100 preferably comprises an articulating
mechanism for articulating distal segment 140 towards (and away
from) segment 130 and a drive mechanism for actuating the medical
tool. The articulation and drive mechanism are operated from handle
110 or from optional adaptor 120 as will be further described with
respect to FIGS. 11 and 12 below. Elements of the articulation and
drive mechanism pass through proximal segment 130 which optionally
consists of a plurality of layers, for example 2, 3, 4 or more
layers.
[0107] FIGS. 1C-1E are more detailed, partially cross-sectional
views of the drive mechanism and lever of instrument 100 in the
straight configuration (FIG. 1C) and in two different articulation
configurations (FIGS. 1D and 1E). The layers of segment 130 will be
described with reference to the cross-sectional views. Any of the
layers may surround less than the entire circumference of the
segment, for example, any of the layers may surround the entire
360.degree. of the circumference or as less as only 30.degree. of
the circumference of segment 130.
[0108] An outer layer of proximal segment 130 will be referred
herein as housing 132. Housing 132 optionally does not surround
entire segment 132, for example as shown in FIG. 1C, the outer
layer of segment 130 comprises of housing 132 and partial housings
112, 223 and 225.
[0109] An articulation mechanism is provided for articulating
distal segment 140 towards or away from proximal segment 130. In
the embodiments of FIG. 1, the articulation mechanism is a lever
mechanism which articulates distal segment 140 around hinge 116.
The lever mechanism consists of partial housing 112 that acts as a
lever for controlling and/or stabilizing articulation of distal
segment 140, as shown in FIGS. 1D and 1E. Lever 112 is attached by
a lever hinge 124 to a drive element 118. Drive element 118 is a
hollow tube which is driven from handle 110 or adaptor 120 in a
direction 133 and thereby slides lever 112 distally and articulates
distal segment 140 around hinge 116, forming articulation angle
135. Drive element 118 is positioned within (or partially within)
housing 132 and constitutes a second layer of segment 130.
[0110] A drive mechanism is further provided for actuating a
medical tool at (or in) distal segment 140. Optionally (and as
shown), the drive mechanism transfers rotary motion to a medical
tool. Alternatively or additionally, the drive mechanism transfers
linear movement to the medical tool or to an actuator that controls
the medical tool. The drive mechanism does optionally not follow
substantially straight lines between the proximal and distal
segment at the apex of articulation angle 135, but forms an angle
137 which is smaller than articulation angle 135.
[0111] Drive mechanism 150 includes a proximal shaft 210, a gear
mechanism 220 and a distal shaft 230. In the straight
configuration, proximal shaft 210 and distal shaft 230 are
positioned within (or parallel to) proximal segment 130 and
constitute a third layer of segment 130. In the articulated
configuration, proximal shaft 210 extends from beneath proximal
segment 130 and distal shaft 230 is positioned continuous to
straight distal segment 140. Proximal shaft 210 is partially
positioned in housing 112. Distal shaft 230 may partially be
positioned in a housing 117 which extends from segment 140.
[0112] Proximal shaft 210 is connected by a link 121 to an inner
tube drive 134 which is also part of the third layer of segment
130. In the articulated configuration, shaft 210 extends axially
out of segment 130, requiring compensation the distance at the
point of attachment of shaft 210 to inner tube drive 134. An
exemplary distance compensation mechanism is shown and detailed
with respect to FIG. 10 below. Additional links may be provided in
proximal shaft for increasing flexibility of shaft 210, for
example, link 122 is provided attaching a first rod 123 of shaft
210 with a second rod 125 (shown in FIG. 1D), such that rods 123
and 125 are articulated.
[0113] Gear mechanism 220 consists of face gears 221 and 229,
attached to proximal shaft 210 and distal shaft 230 respectively.
Gears 222, 224 and 226 are provided between face gears 221 and 229.
Although three gears are shown, any number of wheels can be used in
accordance with embodiments of the present invention, for example
1, 2 or 4 gears. By rotation of tube 134 (from handle 110 or
adaptor 120), torque is transferred through link 121 (and optional
links 122) to shaft 210 which causes face gear 221 to rotate and
rotates gears 222, 224 and 226 to face gear 229, thereby rotating
distal shaft 230.
[0114] Supports 223 and 225 are optionally provided for holding
gears 222, 224 and 226 respectively, while allowing rotation of the
gears. Supports 223 and 225 are interconnected by a hinge 227 which
defines an additional axis around which gear mechanism 220 can
rotate, thereby allowing shaft 230 to bend towards shaft 210 in the
articulated configuration of instrument 100.
[0115] During articulation, gear 226 rotates around hinge 227 and
around gear 224. Rotation around gear 224, may cause face gear 229
to rotate, thereby transferring undesired rotary motion to segment
140. In some embodiments, this undesired rotary motion is disabled
by the addition of a coupler that separates face gear 221 from gear
222 during articulation. By this separation, the articulation of
gear 226 around hinge 227 causes rotation of gears 224 and 222
rather than rotation of face gear 229 and segment 140.
[0116] FIGS. 1F-1H illustrate a coupler 270 for separating face
gear 221 from gear 222. FIG. 1F illustrates coupler 270 activated,
where face gear is joined to gear 222 and FIG. 1G illustrates
coupler 270 deactivated, where face gear 221 is separated from gear
222 and reveals a rod 231 between face gear 221 and gear 222. FIG.
1H is a closer view of coupler 270. Tube 134 includes at its end a
spring which is surrounded by a helical tube 274. A handle 276 is
provided for actuating coupler 270. Handle 270 includes teeth 273
at the inner side, facing helical tube 274. By pushing handle 270
in the direction 275 (i.e. from the position shown in FIG. 1F to
the position shown in FIG. 1G), teeth 273 are inserted into helical
tube 273 and pull tube 134 such that facial gear 221 separates from
gear 222 and reveals rod 231.
[0117] Handle 272 is positioned as shown in FIG. 1F before or after
articulation is to performed and is positioned in the position
shown in FIG. 1G during articulation. Coupler 270 is preferably
positioned at the end of segment 130 and is not inserted into a
body tissue. In some embodiments, coupler 270 is integrated in the
mechanism which is activating the lever.
[0118] At least one wire or cable 136 may further be provided,
passing through drive mechanism 150 and constituting a fourth layer
of segment 130. Wire 136 is optionally an additional drive
mechanism adapted to transfer linear motion to the medical tool or
to an actuator of the medical tool. Optionally, wire 136 is pushed
or pulled from handle 110 or adaptor 120.
[0119] FIGS. 2A and 2B are cross sectional views of exemplary
medical tools actuated by an instrument according to some
embodiments of the invention. FIGS. 2A and 2B illustrate the
instrument shown in FIGS. 1A-1F, it is understood that the medical
tools may be actuated in accordance with any exemplary embodiment
of the invention.
[0120] FIG. 2A illustrates a tacker 250 positioned within distal
segment 140. Tacker 250 includes a long threaded element 252,
having a needle point 253, and a number of helical fasteners 254
threaded around element 252. A plurality of fasteners may be loaded
in accordance with embodiments of the invention, for example
between 1-10 fasteners and deployed as desired. Element 252 and
fasteners 254 are positioned within an internally threaded sleeve
256 which is positioned in an outer layer 258 of segment 140.
Optionally, needle point 253 is positioned out of sleeve 256.
[0121] In order to fasten fasteners 254 in a body, needle point 253
is stabbed in a body tissue and fasteners 254 are then rotated by
sleeve 256 till they exit from threaded element 252 and are
fastened within the body tissue. In some embodiments, element 252
does not advance but remains static and segment 140 withdraws. A
retraction spring 259 may be provided at segment 140, where needle
end 253 is positioned. By forcing segment 140 on to a body tissue,
retraction spring 259 contracts, thereby revealing needle end 253.
Optionally, retraction spring 259 is positioned at the end of
segment 140 as shown in FIG. 2A. Alternatively, retraction spring
259 is positioned at any other position of segment 140. Any
retraction spring known in the art can be used in accordance with
embodiments of the present invention. Optionally, a collapsible
element which provides a controlled threshold force is used as a
retraction spring, in order to prevent undesired exposure of end
253. In these embodiments, element 252 is static and to does not
move during actuation of tacker 250.
[0122] In an alternative embodiment, retraction spring 259 is not
present and element 252 moves in linear direction, for example by a
spring provided at the end of the needle, opposite to end 253.
Element 252 is controlled from handle 110 or adaptor 120. Element
252 can optionally freely move linearly during articulation of
distal segment 140 but should only controllably move in the linear
direction after articulation is completed in order to stab the
needle in a body tissue. A distance compensation mechanism for
element 252 is detailed with respect to FIGS. 8 and 9 below.
[0123] FIG. 2B illustrates an alternative tacker to be actuated in
accordance with an exemplary embodiment of the invention. A tacker
260 is shown contained within distal segment 140. Tacker 260
includes a number of helical fasteners 264 inside an internally
threaded tube 266. Tube 266 has a number, for example 2,
longitudinal slits through which wings 265 of fasteners 264 extend.
Tube 266 is shown cut off at the end of segment 140 for clarity but
covers all of fasteners 264. Fasteners 264 are held by wings 265 in
threads 268 of segment 140. By transfer of rotary movement through
the drive mechanism, tube 266 is rotated, thereby advancing
fasteners towards the end of segment 140 and then screwed in a body
tissue. In the embodiment shown in FIG. 2B, no linear movement
mechanism is required.
[0124] FIGS. 3A and 3B illustrate a drive mechanism in accordance
with another embodiment of the invention. FIG. 3A shows a straight
configuration in which sliding lever 112, housing 117 and a drive
mechanism 320 are positioned parallel to proximal shaft 130. In the
articulated configuration shown in FIG. 3B, drive mechanism 320 is
positioned partially within lever 112 and housing 117. Drive
mechanism 320 replaces shafts 210 and 230 and drive mechanism 220
in the embodiment shown in FIG. 1.
[0125] Drive mechanism 320 is a flexible shaft, generally
positioned within a canella in a sheath, which is positioned within
segments 130 and 140 in the straight configuration and is attached
to a medical tool at or in segment 140. Shaft 320 is preferably
controllable from handle 110. In the straight configuration, shaft
320 follows the shape of (and is positioned within) substantially
straight segment 130. In the articulated configuration, drive
mechanism 320 extends from a joint 322 connecting lever 112 and
housing 117 and is not wholly positioned within lever 112 and
housing 117, as shown in to FIG. 3B.
[0126] Rotation of shaft 320 from handle 110 transfers torque
through the instrument, thereby rotating medical tool at or in
segment 140. In some embodiments, shaft 320 is hollow and other
drive mechanisms can be passed through hollow shaft 320. For
example, as shown in FIGS. 3A and 3B, a wire 136 is positioned
within hollow shaft 320. It is understood that more than one wire
136 can be passed through shaft 320, for example two or more
wires.
[0127] In some embodiments of the invention, a conduit is passed
through shaft 320 for injection of medication in a body tissue.
Alternatively or additionally, tissue samples are collected through
the conduit by for example applying a vacuum suction.
[0128] FIGS. 4A-4G illustrate a drive mechanism 420 in accordance
with yet another embodiment of the invention. Drive mechanism 420
is shown situated between proximal shaft 410 and distal shaft 430.
FIGS. 4A-4F illustrate the drive mechanism without a surrounding
instrument. An exemplary surrounding instrument is shown in FIG. 4F
and is similar to the instrument shown in FIGS. 1-3. Other
instruments may be used in accordance with exemplary embodiments of
the invention, for example instruments where the drive mechanism
follows substantially straight lines between the proximal and
distal segments at the apex of the articulation angle.
[0129] Drive mechanism 420 consists of three pairs of rods 422a and
424a, 422b and 424b and 422c and 424c, generally referred
hereinafter as rod pairs 422 and 424. Rods 422a, 422b and 422c are
connected to proximal shaft 410 and rods 424a, 424b and 424c are
connected to distal shaft 430. Each pair of rods is interconnected
by hinges 423a-c respectively. Hinges 423a-c are optionally planar
hinges or joints which can articulate in one direction only.
[0130] Rotary motion is transferred from proximal shaft 410 through
rod pairs 422 and 424 to distal shaft 430. Substantially any number
of rod pairs 422 and 424 can be used for example 1, 2 or 4 rod
pairs. Preferably, the rod pairs are spaced angularly equally apart
from each other and are within the diameter of shafts 410 and 430.
A passageway 428 situated between rod pairs 422 and 424 enables one
or more additional drive mechanisms to be passed through central
holes 412 and 414 of shafts 410 and 430 respectively, for example a
linear movement mechanism such as a spring or wire.
[0131] Drive mechanism 420 can freely rotate in the straight
configuration shown in FIG. 4A and in an articulated configuration,
for example as shown in FIG. 4B. Since planar hinges 423a-c are
used to connect rod pairs 422 and 424, the rods can articulate at
two angles only and should be aligned such that the different rods
will always articulate in the same direction. An alignment
mechanism 440 is optionally provided for keeping rod pairs 422 and
424 aligned in the straight and articulated configuration. FIG. 4C
is a closer view of alignment mechanism 440. Alignment mechanism
440 is shown attached to proximal shaft 410 but could be attached
to distal shaft 430 in accordance with exemplary embodiments of the
invention.
[0132] Rods 422a-c are partially contained in housings 425a-c
respectively. FIG. 4E is a closer view of an exemplary rod 422 and
housing 425. Rods 422 include extensions 432 which fit in
longitudinal slots 435 of housing 425, thereby preventing rods 422
from rotating with respect to housings 425.
[0133] Housings 452a-c include axles 426a-c at their ends which are
received in a disk 460. Axles 426a-c are eccentric of the axes of
housings 426a-c (and this of rods 422) and disk 460 is positioned
eccentric to shaft 410. Preferably, axles 426a-c are eccentric by
the same amount and in the same direction as disk 460. The
eccentric positions of axles 426a-c and disk 460 assure that
housings 426a-c will not rotate around their axis during rotation
of disk 460.
[0134] FIG. 4D illustrates the rotation of disk 460 with an
exemplary housing 425. A1 indicates the center of knob 426 and A2
indicates the center of housing 425 and a rod 422. O1 indicates the
center of disk 460 and O2 indicates the center of shaft 410. The
distance between A1 and A2 equals the distance between O1 and O2.
During rotation of disk 460 in the direction 450, housing 425 (and
knob 426) move from a position 452 to a position 454. During
rotation, the distance between A1 and A2 remains equal to the
distance between O1 and O2, thereby preventing rotation of housing
425 around its axis.
[0135] An additional alignment requirement is a linear alignment,
preventing rod pairs 422 and 424 to move in a linear direction so
that the joints will always be positioned on the same axis. A
spring 442a-c is provided between each rod 422a-c and the end of
housing 425a-c for controlling linear movement of the rods. The
rods are able to slide within their respective housings to change
the length of the rod/housing configuration as required.
[0136] In accordance with another embodiment of the invention, rod
pairs 422 and 424 are interconnected by a flexible element 433,
which can bend at any direction, for example as shown in FIG. 4F.
The use of flexible element eliminates the use of alignment
mechanism 440 since the rod pairs can bend around any axis.
Flexible element 433 is preferably not stretchable and may be made,
for example, of nitinol or non-stretchable nylon. In some
embodiments, a linear alignment mechanism, for example springs
442a-c, is provided for linear alignment of the rod pairs. However,
housings surrounding the rods need not be slotted and the
eccentricities described above are not generally provided.
[0137] FIG. 4G is a cross-sectional view of medical instrument 400
with a drive mechanism 420 as shown in FIGS. 4A-4F. Medical
instrument 400 is similar to instrument 100 shown in FIG. 1, except
for the drive mechanism. Distal segment 402 and proximal segment
401 are shown. A tacker, similar to the tacker shown in FIG. 2A, is
positioned within distal segment 402. The tacker consists of a
threaded shaft 470 and screws 480. In the embodiment shown in FIG.
4G, shaft 470 is static and a retraction spring 490 is provided at
the end of segment 402, where a needle end 472 is positioned. Thus,
by forcing segment 402 on to a body tissue, retraction spring 490
contracts, thereby revealing needle end 472.
[0138] In order to keep shaft 470 static, a tube 474 is provided
through drive mechanism 420, supporting shaft 470. Tube 474
optionally also has a joint 475 allowing tube 474 to bend with rod
pairs 422 and 424. Alternatively, tube 474 is relatively flexible
such that it can bend and follow the articulation of drive
mechanism 420.
[0139] Optionally, shafts 470 and 474 are replaced by a conduit for
collecting tissue samples and/or injection of medication.
[0140] FIG. 4H illustrates an instrument similar to the instrument
shown in FIG. 4G, where forceps 485 are provided at the end of
distal segment. The forceps are actuated by a cable 486 that passes
through central holes 412 and 414 of the drive mechanism. The
rotation provides for changing the aspect of the forceps.
[0141] A number of drive and articulation mechanisms for instrument
100 are provided in accordance with embodiments of the present
invention. In general, the drive and articulation mechanisms can be
separated into two groups. A first group in which the drive
mechanism and lever are positioned exterior of the articulation
angle, for example as shown in FIGS. 1-4 and described above. In
this group, the lever is pushed in order to articulate the distal
segment towards the proximal segment. A second group of a drive
mechanism and lever which are positioned interior of the
articulation angle, for example as shown in FIGS. 5 and 7 and
described below. In the second group, the lever is pulled in order
to articulate the distal segment towards the proximal segment. In
both groups, the drive mechanism does not follow the articulation
angle and is not substantially affected by forces involved in
articulating and maintaining an articulated configuration of the
instrument.
[0142] A detailed description of the second group is now provided
with reference to FIGS. 5-7.
[0143] FIGS. 5A-5C illustrate a drive and articulation mechanism
500 in accordance with another embodiment of the invention. FIG. 5A
illustrates a straight configuration and FIG. 5B illustrates an
articulated configuration in which a substantially straight distal
segment 530 is bendable towards a substantially straight proximal
segment 510. An articulation angle 542 exists at the junction of
segments 510 and 530 at a joint 540. Joint 540 can be any joint
known in the art, for example a planar pivot. In some embodiments,
no joint 540 is provided and articulation angle 542 is defined by
(virtual) continuation of straight segments 510 and 530.
[0144] A lever 550 is provided for articulating segment 530 towards
segment 510. Lever 550 is controlled from handle 110 or adaptor 120
shown in FIG. 1 and detailed with respect to FIGS. 11 and 12 below.
A first end 552 of lever 550 is attached to proximal segment 510
and a second end 554 of lever 550 is attached to distal segment
530. In the straight configuration shown in FIG. 5A, lever 550 is
positioned parallel to (or within) segments 510 and 530. In the
articulated configurations shown in FIG. 5B, lever 550 is extended
out of segments 510 and 530 and is positioned between segments 510
and 530, interior of articulation angle 542.
[0145] In order to extend out of segments 510 and 530, lever 550
should be slidably attached to the proximal segment, so as to allow
for a distance change in the point of attachment to the segment.
FIG. 5C is a cross-sectional view of the articulated configuration
of FIG. 5B. FIG. 5C shows end 552 of lever 550 attached by a lever
hinge 556 to drive element 536 which slides along a drive mechanism
580.
[0146] Drive mechanism 580 is a flexible shaft, generally
positioned within a canella in a sheath, which is positioned within
segments 510 and 530 in the straight configuration. In the
articulated configuration, shaft 580 extends from segments 510 and
530 and is positioned between articulation angle 542 and lever 550.
By extension of drive mechanism 580 out of joint 540, drive
mechanism 580 is less affected by forces involved with articulating
segments 510 and 530, for example forces indicated by arrows 562
and 564 forces 562 and 564 may also represent external forced
applied when the surgical tool is forced to the patient body. In
the articulated configuration, drive mechanism 580 is positioned
within the articulation angle but does not pass through straight
lines between the proximal and distal segment at the apex of angle
542. In the embodiment shown in FIGS. 5, drive mechanism 580 does
not pass through joint 540.
[0147] Shaft 580 is attached to a medical tool at the end of
segment 530, for example forceps 590 as shown in FIGS. 5B and 5C.
Shaft 580 is preferably controllable from handle 110 and optionally
transfers rotary motion from segment 510 through segment 530 to
rotate forceps 590. In some embodiments, shaft 580 is hollow and
enables one or more additional drive mechanisms to pass
therethrough such as wire or cable that transfers linear
motion/force that closes the forceps against the force of spring
592. Alternatively or additionally, shaft 580 may transfer both
rotary and linear motion from segment 510 through segment 530 to
forceps 590. For example, as shown in FIG. 5C, a spring 592, part
of the actuation mechanism, is provided in segment 530 for
actuating forceps 590.
[0148] Shaft 580 may be any flexible shaft known in the art. FIG.
5D illustrates exemplary flexible shafts that can be used in
accordance with exemplary embodiments of the present invention, for
example a sheath or a plurality of interconnected links or joints.
The shafts shown in FIG. 5D can also be used as replacements for
shaft 320 shown in FIG. 3B.
[0149] In some embodiments of the invention, shaft 580 is a
flexible conduit through which medication or tissue samples are
provided. FIG. 5E is a cross-sectional view of end 142 of distal
segment 140 showing a syringe 2013 at the end of conduit 580. A
needle support 2012 is provided attached by a lever 2011 to conduit
580. When shaft 580 lever 2011 is pushed, syringe 2013 is revealed
and can be stabbed in a body tissue for injecting medication or
collecting tissue samples.
[0150] FIGS. 6A and 6B illustrate an exemplary embodiment of the
invention where hinge 540 is replaced by three interconnected links
622, 623 and 624. In the embodiment shown in FIGS. 6A-B, no planar
hinge 540 is provided for supporting articulation of segments 510
and 530. Articulation angle 542 is defined by continuing segments
510 and 530, as shown by dotted lines in FIG. 6A.
[0151] FIG. 6B is a partial cut away isometric view of the flexible
hinge shown in FIG. 6A. A tacker 690 is provided within distal
segment 530. A flexible shaft 628 is provided in segment 510 and
through links 622 and 624 for transferring rotary motion.
Optionally, at least one wire 626 is provided within shaft 628 for
transferring linear motion. Optionally, wire 626 pulls back the
central elongated needle and serves as a fixating mean of the
central needle while the tackers are rotated around the central
needle as detailed with respect to FIG. 2A. Alternatively, wire 626
is movable and dynamically actuates the needle of the tacker or any
other medical tool, for example by pulling the wire.
[0152] FIG. 6C illustrates an embodiment where links 622, 623 and
624 are replaced by a plurality of closely interconnected links
630.
[0153] FIGS. 7A-7C illustrate a surgical instrument similar to the
instrument described in FIGS. 5 above, where flexible shaft 580 is
replaced with a substantially rigid rod 520.
[0154] FIG. 7A illustrates a straight configuration where segments
510 and 530 form a substantially straight line and FIG. 5B shows an
articulated configuration where segment 530 is bent towards segment
510.
[0155] Drive mechanism 520 is attached at a first end, optionally
by a cardan joint 522, to a shaft 556 in proximal segment 510 and
at a second end, optionally by a cardan joint 524, to a drive shaft
(shown in FIG. 7B) in distal segment 530. In the straight
configuration, drive mechanism 520 is located parallel to or within
segments 510 and 530. Drive mechanism 520 extends from segments 510
and 530 in the articulated configurations.
[0156] In order to extend out of segments 510 and 530, drive
mechanism 520 should be slidably attached to (or in) the proximal
segment, so as to slide along the segment and compensate the
distance at the point of attachment to the segment. In the
embodiment shown in FIG. 7B, drive mechanism 520 is attached by
cardan joint 522 to an inner tube 514 in segment 510. The distance
of the point of attachment of drive mechanism 520 to to inner tube
514 should be compensated as the articulation angle changes. A
detailed explanation of exemplary distance compensation mechanism
in accordance with exemplary embodiments of the invention is
provided with respect to FIG. 10 below.
[0157] In the embodiments shown in FIGS. 7A-C, drive mechanism 520
is a shaft which is attached by cardan joints to tubes in segments
510 and 530. The cardan joints allow the transfer of rotary
movement from proximal segment 510 to distal segment 530. Shaft 520
may be hollow so as to enable additional drive mechanisms to be
gated therethrough, for example linear movement mechanism such as
at least one wire 516 shown in FIG. 7B.
[0158] In some embodiments of the invention, a sheath 570 is
provided covering the drive and articulation mechanisms, for
example as shown in FIG. 7C. Sheath 570 prevents body tissues from
being caught in the drive and articulation mechanisms. Sheath 570
is optionally made of a biocompatible material with a sufficient
flexibility so as not to be damaged by the stretching forces
applied to it during articulation, for example silicon or
rubber.
[0159] Sheath 570 (or a similar sheath adapted for the specific
configuration) may be provided in all embodiments of the present
invention, for example in the embodiments shown in FIGS. 1-6.
[0160] In the embodiments of FIGS. 5-7, the space between the
articulation hinge and the point of connection of the lever to the
distal segment is lost, meaning that no medical tool can be
positioned therein, thereby requiring a longer distal segment as
opposed to the embodiments shown in FIGS. 1-4. Thus, the choice
between a drive mechanism positioned in the articulation angle and
a drive mechanism positioned underneath the articulation angle may
depend on the medical tool used and/or the treatment performed. For
example, when a tacker is positioned within the distal segment, a
substantial section of the distal segment is used, while
positioning forceps at the end of the distal segment does not
require use of the entire length of the distal segment.
[0161] An exemplary distance compensation mechanism 800 for a
threaded element of a tacker is shown in FIG. 8. Distance
compensation mechanism 800 consists of a tube or rod 810 whose
linear position is to be controlled. Tube 810 represents for
example a tube connected to threaded element 252 in FIG. 2A which
is required to freely move in a linear direction (indicated as 812
in FIG. 8) during articulation of instrument 100 and should
controllably move in a linear direction after articulation is
completed in order to stab the needle in a body tissue.
[0162] Tube 810 comprises a screw-814 which is threaded inside a
gear 816. Gear 816 engages a gear 818. Screw 814 and gear 816 are
forced by spring to move along with tube 810 in the backward
direction of 812 while gear 818 rotates but does not move linearly.
After articulation is completed, and gear 816 is situated in its
new position, the relative movement of tube 810 from it's
current/new position is controlled by gear 818. When advancement of
shaft 810 is required, gear 818 rotates in a direction 820 which
rotates gear 816 in a direction 822 around screw-nut 814, thereby
advancing tube 810. Opposite rotation is provided in order to
return the needle backwards.
[0163] FIGS. 9A-B illustrate a distance compensation mechanism 900
for a threaded element of a tacker in accordance with another
embodiment of the invention. Distance compensation mechanism 900
can be used as a replacement for mechanism 800 described above.
[0164] Mechanism 900 includes a tube 910 which slides along the
direction 912 during articulation. Tube (or rod) 910 and a spring
914 surrounding the end of tube 910 are positioned in a receptacle
916. The end of tube 910 is attached to a saw-tooth plate 918.
Finger like elements 920 are provided which after articulation is
completed and tube 910 is within it's new position, engage with saw
tooth plate 918 to provide controlled movement of tube 910 in the
direction 912, for example to stab a needle in a body tissue. Teeth
920 are forced towards plate 918 by receptacle 916. A cam 922, or
other mechanism, is provided for controllably advancing tooth plate
910 (and tube 910) after articulation is completed.
[0165] In some embodiments, the fingers of tooth plate 920 are
slightly distant from each other in the direction 912 such that at
any point of engagement of elements 920 with plate 918, at least
one finger is provided in a tooth of plate, thereby blocking
movement of plate 918 and applying force in a linear direction.
FIG. 9 illustrates 4 teeth, however, any number of teeth may be
used in accordance with embodiments of the invention. An increased
number of teeth increases accuracy of the mechanism.
[0166] FIG. 10 illustrates a distance compensation mechanism which
enables variation of the length of a tube 1010 and enables rotation
of a tube 1010 at varying longitudinal positions thereof. This may
for example be required when compensating distance of to tubes
relating to the drive mechanism, such as tube 134 in FIGS. 1A-1E or
tube 514 in FIG. 7B which are required to move linearly during
articulation in order to vary the point of attachment of the drive
mechanism and to remain steady after articulation is completed. A
further requirement from tubes 134 and 514 is that they should be
able to rotate at any longitudinal position thereof in order to
transfer rotary motion from the proximal segment to the distal
segment.
[0167] Tube 1010 includes a shaft 1012 within a portion of tube
1010 and extending therefrom. Shaft 1012 is moveable in the
direction 1014, thereby varying the longitudinal position of tube
1010. Shaft 1012 optionally includes a male element 1016 engaged in
a female element 1018 of tube 1010. The engagement of elements 1016
and 1018 enables a rotation of shaft 1012, for example in a
direction 1020 to be transferred to rotation of tube 1010 in a
direction 1022.
[0168] Reference is now made to handle 110 shown in FIG. 1. Handle
110 enables a user to control the articulation mechanism and one or
more drive mechanisms of instrument 100. In some embodiments,
handle 110 includes one or more mechanisms as illustrated in FIGS.
8 and 9.
[0169] FIG. 11A is a cross-sectional view of a handle 110 in
accordance with an exemplary embodiment of the invention. Handle
110 comprises a grip 1120 for controlling the drive mechanism, for
example. Distance compensation mechanism 800 is optionally provided
for compensating distance of a threaded element of a tacker
position in segment 140. Handle 110 may further comprise a screw
nut 1140 around a screw 1160 for controlling articulation by
pulling or pushing a lever. Other control mechanisms may be used in
accordance with exemplary embodiments of the present invention. For
example, in accordance with some embodiments, the drive mechanism
and/or lever are motorized.
[0170] FIG. 11B is a partially cross sectional view of a handle
2001 used for actuation of a drive mechanism including a conduit in
order to inject medication or collect tissue samples, for example
as shown and described with respect to FIG. 5E. A handle 2004
positioned at the end of proximal segment 130 for linear movement
of a syringe at the end of distal segment 130, as shown in FIG. 5E.
An additional handle 2002 activates an injection device 2003 in
handle 2001. Container 2005 includes medication 2007 and is
attached at one end to a conduit 2008 and at the other end to a
support 2009, attached to a rod 2006. In some embodiments,
injection device 2003 functions as an aspiration device for
collection of tissue samples. In these embodiments, an additional
handle is provided which pushes rod 2006 to the proximal direction
to create a vacuum within conduit 2008.
[0171] In some embodiments of the invention, an adaptor 120 is
provided between handle 110 and proximal segment 130. Adaptor 120
may be used in order to use the instrument as an add-on to existing
instruments, whereby an existing handle is connected to an adaptor
and proximal and distal segments, and an existing medical tool is
position within or at the distal segment.
[0172] FIGS. 12A-12C illustrate an adaptor in accordance with an
exemplary embodiment of the invention. FIG. 12A is a partially
cross sectional view of an instrument as shown and described with
respect to FIGS. 1. FIG. 12B is a closer view of the cross-section
of the adaptor in FIG. 12A and FIG. 12C is an upper view of the
adaptor.
[0173] Adaptor 120 includes a shaft 1270 which is attached to
proximal segment 130. An articulation control mechanism 1210 is
provided, consisting of a screw nut 1220 on a screw 1230 connected
to a lever mechanism having a first lever 1240 and a second lever
1250 which are connected drive element 118. Rotation of screw-nut
1220 pushes (or pulls) first lever 1240 which pushes (or pulls)
second lever 1250 which in turn pushes (or pulls) drive element 118
which pushes lever 112 and causes articulation of distal segment
140 around joint 116.
[0174] In some embodiments, control of the drive mechanism is
transferred from the handle through the adaptor.
[0175] Although adaptor is described with respect to the embodiment
of FIG. 1, it is understood that adaptor 120 may be used with any
of the embodiments of the invention, for example, adaptor 120 may
be used with the embodiment illustrated in FIG. 5 where second
lever 1250 will be attached to drive element 536.
[0176] Throughout this application, specific embodiments of
instrument are described for clarity with specific combination of
articulation mechanisms, drive mechanism and medical tools. It is
understood that embodiments of the present invention include any
combination of the articulation mechanisms, drive mechanisms and
medical tools described with respect to specific embodiments.
[0177] It is expected that during the life of a patent maturing
from this application many relevant articulation and drive
mechanisms will be developed and the scope of the terms
articulation mechanism and/or drive mechanisms intended to include
all such new technologies a priori.
[0178] As used herein the term "about" refers to .+-.10%.
[0179] The terms "comprises", "comprising", "includes",
"including", "having" and their conjugates mean "including but not
limited to".
[0180] The term "consisting of" means "including and limited
to".
[0181] The term "consisting essentially of" means that the
composition, method or structure may include additional
ingredients, steps and/or parts, but only if the additional
ingredients, steps and/or parts do not materially alter the basic
and novel characteristics of the claimed composition, method or
structure.
[0182] As used herein, the singular form "a", "an" and "the"
include plural references unless the context clearly dictates
otherwise. For example, the term "a joint" or "at least one joint"
may include a plurality of joint, including interconnected
links.
[0183] Throughout this application, various embodiments of this
invention may be presented in a range format. It should be
understood that the description in range format is merely for
convenience and brevity and should not be construed as an
inflexible limitation on the scope of the invention. Accordingly,
the description of a range should be considered to have
specifically disclosed all the possible subranges as well as
individual numerical values within that range. For example,
description of a range such as from 1 to 6 should be considered to
have specifically disclosed subranges such as from 1 to 3, from 1
to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as
well as individual numbers within that range, for example, 1, 2, 3,
4, 5, and 6. This applies regardless of the breadth of the
range.
[0184] Whenever a numerical range is indicated herein, it is meant
to include any cited numeral (fractional or integral) within the
indicated range. The phrases "ranging/ranges between" a first
indicate number and a second indicate number and "ranging/ranges
from" a first indicate number "to" a second indicate number are
used herein interchangeably and are meant to include the first and
second indicated numbers and all the fractional and integral
numerals there between.
[0185] It is appreciated that certain features of the invention,
which are, for clarity, to described in the context of separate
embodiments, may also be provided in combination in a single
embodiment. Conversely, various features of the invention, which
are, for brevity, described in the context of a single embodiment,
may also be provided separately or in any suitable subcombination
or as suitable in any other described embodiment of the invention.
Certain features described in the context of various embodiments
are not to be considered essential features of those embodiments,
unless the embodiment is inoperative without those elements. For
example, specific medical tools are described as used with specific
embodiments of the invention, it is appreciated that any medical
tool may be used with any of the exemplary embodiments
described.
* * * * *